ORDER

1. JUSTICE A.K. SAMANTARAY, PRESIDENT - The complainant, who is a retired IPS officer and former Director General of Police, Orissa, has in this consumer complaint alleged serious deficiency in service on the part of the opposite parties.

2. The complainant's case is that he had purchased Indian Overseas Bank Healthcare Plus policy of United India Insurance Company Ltd. (for short 'UIIC') for an assured sum of Rs.5,00,000/- vide No.2007/484101384/1. The cashless claim for hospitalization of the complainant due to illness clearly falls within the purview of and in all fours of the UIIC Circular containing terms and conditions of the Indian Overseas Bank Healthcare Plus policy. The complainant had been under cover of Health Insurance policy of Oriental Insurance Company from 1998 to 2007 and thereafter taken over and renewed with UIIC through the Indian Overseas Bank from 2008 without any break in insurance. Being fully satisfied after perusal of all previous policy papers of another Indian Insurance Company, i.e., the Oriental Insurance Company, and on receipt of the prescribed premium amount through the Indian Overseas Bank, the UIIC issued in favour of the complainant the certificate for Indian Overseas Bank Healthcare policy. The complainant having been found eligible for the above cashless benefit for hospitalization in any TTK network hospital in eastern India, the Third Party Administrator of UIIC M/s TTK Healthcare TPA Pvt. Ltd. provided the complainant with UIIC Health Card No. CHE-UI-1801-01-17789 with TTK monogram valid up to 27.02.2009. The Complainant’s claim for cashless hospitalization, as promised and guaranteed by the UIIC Ltd. arose within the period of validity of the contractual policy binding upon the UIIC Ltd. and its service provider M/s TTK Health Care TPA Pvt. Ltd. In the morning of 20.11.2008, the complainant, a widower living alone in his residence, felt acute, unbearable and excruciating pain over his left hip joint radiating up to the leg. He was rushed immediately by some of his well wishers and neighbours to the emergency ward of the Ashwini Hospital, Cuttack, which is one of the TTK's network hospitals, for treatment. On production of TTK's valid healthcare card entitling the complainant to cashless hospitalization, the said hospital admitted the complainant as inpatient A 1275 and took immediate follow up by way of check up, X-Ray, MRI, blood tests, etc. with due intimation to the TPA in conformity with the formalities, as is the practice in such cases in all network hospitals. The complainant was informed by Shri Bijay Kumar Sahoo, General Manager (Operation) of Ashwini Hospital that he was admitted on emergency after telephonic conservation with TTK's Bangalore office as the Chennai office of TTK could not be contacted by any means despite repeated efforts. Although the Ashwini Hospital dispatched the authorization application along with requisite investigation reports and complied with all queries of TTK made over phone from time to time, the hospital authorities failed to secure authorization and sanction, of advance from TTK, which frustrated the very purpose of TPA Health Card issued to the complainant promising and guaranteeing cashless hospitalization. It is categorically stated by the complainant that the copies of the letters/Fax/e-mails exchanged between the Ashwini Hospital and M/s TTK Healthcare TPA Pvt. Ltd., which are there in custody of the hospital authorities, are clear proof of TPA's stubborn attitude and lack of commitment and devotion to duty in total disregard to the safety and security of the customer-patient, that too of senior citizens. Till the date of discharge of the complainant from the hospital, i.e.; afternoon of 26.11.2008, the hospital authorities got no response, written or otherwise, from any of the offices of M/s. TTK Healthcare TPA Pvt. Ltd in the matter of approval and sanction of advance towards the cost of hospitalization and treatment of the complainan